Respiratory Syncytial Virus During the COVID-19 Pandemic Compared to Historic Levels: A Retrospective Cohort Study of a Health System

Abstract

Background Surveillance in 2020–2021 showed that seasonal respiratory illnesses were below levels seen during prior seasons, with the exception of interseasonal respiratory syncytial virus (RSV). Methods Electronic health record data of infants aged <1 year visiting the Duke University Health System from 4 October 2015 to 28 March 2020 (pre–COVID-19) and 29 March 2020 to 30 October 2021 (COVID-19) were assessed. International Classification of Diseases-Tenth Revision (ICD-10) codes for RSV (B97.4, J12.1, J20.5, J21.0) and bronchiolitis (RSV codes plus J21.8, J21.9) were used to detail encounters in the inpatient (IP), emergency department (ED), outpatient (OP), urgent care (UC), and telemedicine (TM) settings. Results Pre–COVID-19, 88% of RSV and 92% of bronchiolitis encounters were seen in ambulatory settings. During COVID-19, 94% and 93%, respectively, occurred in ambulatory settings. Pre–COVID-19, the highest RSV proportion was observed in December–January (up to 38% in ED), while the peaks during COVID-19 were seen in July–September (up to 41% in ED) across all settings. RSV laboratory testing among RSV encounters was low during pre–COVID-19 (IP, 51%; ED, 51%; OP, 41%; UC, 84%) and COVID-19 outside of UC (IP, 33%; ED, 47%; OP, 47%; UC, 87%). Full-term, otherwise healthy infants comprised most RSV encounters (pre–COVID-19, up to 57% in OP; COVID-19, up to 82% in TM). Conclusions With the interruption of historical RSV epidemiologic trends and the emergence of interseasonal disease during COVID-19, continued monitoring of RSV is warranted across all settings as the changing RSV epidemiology could affect the distribution of health care resources and public health policy.

All Infants Are at Risk of Developing Medically Attended Respiratory Syncytial Virus Lower Respiratory Tract Infection and Deserve Protection

“…Among the available subnational studies, Movva et al [ 20 ] show that the decision to test for RSV varies across and within settings, with only approximately 50% or less of infants seen in an OP setting being tested, except in urgent care clinics where testing is common (84%). Arriola et al [ 19 ] showed that viral testing varies by age.…”

“…Arriola et al [ 19 ] sought to address this by applying multipliers. Similarly to Suh et al [ 23 ], Gantenberg et al [ 24 ] and Movva et al [ 20 ] have addressed this limitation by reporting both the RSV-specific MA-LRTI and the combined total of RSV bronchiolitis and unspecified bronchiolitis as the lower and upper bounds of burden estimates, respectively.…”

The Burden of Respiratory Syncytial Virus Lower Respiratory Tract Disease in Infants in the United States: A Synthesis

“…During the RSV season, most clinical bronchiolitis in doctors’ offices is ascribed to RSV without testing, which it probably is. Before the COVID pandemic, nucleic acid tests for RSV that were quickly becoming the gold standard were expensive, explaining the relative paucity of data for this very common disease in the OP and ED settings [ 29 ]. With the first wave of the pandemic in 2020, it became clear that testing for respiratory viruses was important in the OP setting.…”

Respiratory Syncytial Virus Pediatric Hospitalization in the COVID-19 Era

“…In conclusion, 18 records were included in the revision [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ]. The included studies analyze RSV pediatric hospitalization in COVID-19 era in Asia [ 5 ], America [ 2 ], Europe [ 7 ], and Oceania [ 4 ].…”

“…The included reports had been analyzed and the main highlights are presented in the table [ 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ] ( Table 1 ).…”